Soft Tissue Rheumatism Research Articles

Clinical pattern and prevalence of rheumatic diseases among adults: a community-based cross-sectional study in rural Gadchiroli, India

Background Population-level information on the prevalence of rheumatic disorders from rural India is rare. We investigated the prevalence and patterns of rheumatic disorders among adults in rural Gadchiroli, India. Methods In this population-based, cross-sectional study, trained surveyors conducted a door-to-door survey to identify individuals with pain in back and extremities in two randomly selected villages from this region. Subjects who reported the presence of pain were evaluated by a team of a rheumatologist and orthopedic surgeons in a special clinic organized in these villages. Results Out of 2,535 eligible adults, 2,259 (89%) were surveyed, and 1,247 (55%) reported pain in the back or the extremities, and were therefore referred to the specialist clinic. Out of 884 (71%) participants who attended the clinics, 615 (70%) reported pain in the extremities. The point prevalence of soft tissue rheumatism (STR) in the community was 28% (95% confidence interval, CI=26.1-29.8%) while that of arthritis was 12.2% (10.8-13.5). The point prevalence of rheumatoid arthritis was 0.4% (0.1-0.6). Both STR and arthritis were more common in women and in the elderly. Conclusions Soft tissue rheumatism was the commonest rheumatic disorder in this rural community, followed by arthritis. Inflammatory and infectious disorders were rare. Given the high prevalence of STR and arthritis, community health workers and physicians working in rural areas need to be trained, in order to improve the management of these conditions.

Spectrum of rheumatologic disorders among patients attending with musculoskeletal symptoms: experience from medicine outpatient department of a tertiary care hospital of Bangladesh

Background: Musculoskeletal conditions are prevalent and their impact is pervasive. They are one of the most common causes of long-term pain; affect hundreds of millions of people around the world; they significantly affect the psychosocial status of the affected people as well as their families and carers. This study was done to evaluate the spectrum of rheumatologic disorders among patients attending at medicine outpatient department (OPD) with musculoskeletal symptoms.
 Methods: This cross-sectional study was done at OPD of Medicine, BIRDEM General Hospital from January 2014 to June 2017. All patients attending at OPD having musculoskeletal symptoms, who fulfilled criteria of definite rheumatologic disease and known rheumatologic disorders were consecutively and purposively included in this study.
 Results: Total patients were 495 with female predominance (71.31%). Mean age was 48.6 years (range 18-76 years). Among the study population majority had inflammatory joint and spine diseases (69.69%);then degenerative joint and spine diseases (22.02%), connective tissue diseases (2.22).Two-thirds of the patients had rheumatoid arthritis (RA) (76.23%) among inflammatory joint and spine diseases, then ankylosing spondylitis (AS) (13.33%).Regarding connective tissue disease, systemic lupus erythematosus (SLE) was more frequent (45.5%). Among soft tissue rheumatism and metabolic bone disease, all study subjects had fibromyalgia (FM) and osteoporosis respectively. Rheumatoid factor was positive among two-thirds and anti-CCP antibody in twofifths of RA cases, HLA-B27 was positive in 4.3% of AS, antineuclear antibody (ANA) and anti-ds DNA were positive in all SLE patients. Common co-morbidities were diebetes (41.4%), ischaemic heart disease (20.6%) and hypertension (19.1%).
 Conclusion: RA was the most common inflammatory joint disease. Degenerative diseases were the second most common condition. Common connective tissue disease was SLE.
 Birdem Med J 2021; 11(2): 116-120

Prevalence of musculoskeletal conditions and related disabilities in Bangladeshi adults: a cross-sectional national survey

BackgroundNationally representative data on burden of musculoskeletal conditions (MSK) in Bangladesh are not available. The objective of this study was to determine the prevalence of MSK conditions and related disabilities in the adult population of Bangladesh.MethodsA total of 2000 individuals aged 18 years or older were targeted from 20 primary sampling units (urban and rural) of all former seven divisions of Bangladesh in 2015. Structured interviews were done using the modified Community Oriented Program for Control of Rheumatic Disorders questionnaire to detect positive respondents. Standard criteria were used for diagnosing MSK conditions by rheumatology residents. In case of uncertainty, opinion was taken from senior rheumatologists. A Bangla version of the Health Assessment Questionnaire was used to determine disability.ResultsA total of 1843 (92.1%) participated. Among them, 892 men and 951 women participated from rural (n = 716) and urban (n = 1127) areas. Their mean age was 40.5 (standard deviation 14.7) years. Almost a third did not have any formal schooling. Overall, 30.4% (95% confidence interval, 28.3–32.5) had MSK conditions. Low back pain (18.6%, 16.9–20.5), knee osteoarthritis (7.3%, 6.1–8.5) and soft tissue rheumatism 3.8% (2.9–4.7) were the three top-ranking MSK conditions. Rheumatoid arthritis (1.6%, 1.0–2.1), spondyloarthritis (1.2%, 7–1.8) and adhesive capsulitis (1.4%, 0.9–1.9) were relatively uncommon. Among those who had MSK conditions, 24.8% (21.3–28.6) had some degree of disability. Of them, 24.4% (21.0–28.1) had history of work loss during last 12 months.ConclusionsThe high burden of MSK conditions and related disabilities in Bangladesh warrants greater attention of the health system. Further studies are needed to estimate the impact of this group of conditions particularly addressing related disabilities and loss of work.

Musculoskeletal disorders due to chikungunya virus: A real experience in a rheumatology department in Neiva, Huila

Introducción:Chikungunya (CHIKV) es un virus RNA endémico en algunas regiones de Asia y África. En Colombia en el año 2014 inicia su dispersión de manera explosiva y rápida. La presentación del CHIKV es una condición febril con síntomas musculoesqueléticos que pueden progresar a artropatía erosiva y deformidad poliarticular. El propósito de este estudio es evaluar en pacientes aquejados por la infección por CHIKV en Neiva, Huila que acuden a la consulta de Reumatología, el comportamiento sintomático y serológico, y describir comorbilidades asociadas a la fase crónica de la enfermedad. MétodosSe realizó un análisis observacional, longitudinal y retrospectivo, de datos recolectados en 410 pacientes aquejados por el virus CHIKV con síntomas de más de tres meses de duración que persistían con afecciones musculoesquelíticas y articulares. Los pacientes fueron clasificados según su compromiso en: artralgias postvirales, poliartritis postviral, artritis reumatoide (AR) postCHIKV, espondiloartritis postCHIKV y reumatismo de tejidos blandos. El análisis estadístico fue realizado usando SPSS software (versión 24). Se llevó a cabo análisis descriptivo para evaluar variables cuantitativas como la media (desviación estándar) y variables categóricas como la frecuencia (%). Las variables categóricas fueron comparadas usando la ecuación X2. Como significancia estadística se consideró una p<0,05. ResultadosDe los 410 pacientes, 89,23% fueron mujeres, con compromiso poliarticular en 92,26% de los casos. El 49,83% de los pacientes presentaban de base osteoartritis. Al momento de la evaluación en la consulta de Reumatología, 46,3% de los pacientes cursaron con artralgias no inflamatorias persistentes y 53,7% de los casos presentaban artritis al examen físico, de los cuales, de manera remarcable 20,3% cumplieron criterios para AR postCHIKV. ConclusionesEl desarrollo de síntomas musculoesquelíticos luego de la infección por CHIKV es un problema de salud pública bastante serio, con complicaciones persistentes y riesgo de morbilidad a largo plazo en la vida real. La presencia de artritis postviral neta es de resaltar, sin embargo, el desarrollo de AR postCHIKV requiere usualmente medidas de índole farmacológico más avanzadas, incluso, en algunos casos es necesario referir a los pacientes a terapia biológica. La presencia de síntomas de insuficiencia venosa en miembros inferiores desarrollados con la infección por CHIKV, fue un hallazgo incidental que requiere de un estudio más preciso.

Epidemiology of musculoskeletal complaints and diseases in Qatar: A cross-sectional study.

Background: Musculoskeletal (MSK) conditions are considered a significant public health problem on account of their high prevalence in communities worldwide and their pervasive impact. Knowledge of the epidemiology of MSK symptoms and diseases is lacking in Qatar. Obtaining this information will guide local health policymakers in the future strategic planning of the health budget.Objective: To estimate the prevalence rate of MSK disorders in the Qatari population above 15 years of age using the Community Oriented Program for the Control of Rheumatic Disease (COPCORD) survey.Methods: This cross-sectional study targeted 1000 Qatari participants, including 500 males and 500 females. A door-to-door survey was conducted using the Arabic version of the COPCORD questionnaire with the help of research assistants. Participants with positive surveys were asked to visit Hamad General Hospital Rheumatology outpatient clinics for clinical evaluation by a rheumatologist. When necessary, laboratory testing and X-rays were conducted to confirm any MSK diagnosis.Results: A total of 1239 (males, 50.8%) Qatari individuals randomly selected from the different municipalities of Qatar completed the COPCORD survey. Among the participants, 563 (45.4%) screened positive for MSK pain. Knee pain (24.5%) and back pain (23.3%) were the most common sites of pain, and both conditions showed no gender predominance (p = 0.073 and 0.108, respectively). Shoulder, wrist, hand, hip, and neck pain were significantly predominant in females (p < 0.001 for all). A total of 237 MSK disorders were diagnosed in 196 (15.8%) participants, including 181 degenerative joint diseases, 52 soft-tissue rheumatism conditions, and 4 autoimmune inflammatory disorders. Among degenerative joint diseases, knee osteoarthritis (6.4%) was the most common. Among soft-tissue rheumatic conditions, muscular lower back pain (1.9%), myofascial neck pain (0.64%), generalized body pain (0.32%), and shoulder tendinitis (0.7%) were the most common diseases. The autoimmune inflammatory disorders identified included rheumatoid arthritis (n = 2), connective tissue disease (n = 1), and inflammatory bowel disease-associated arthritis (n = 1).Conclusion: The overall prevalence rate of MSK disorders in this small cross-sectional cohort of Qatari individuals was 15.8%. Knee pain (24.5%) and knee osteoarthritis (6.4%) were the most common MSK complaints and diagnosis in the studied Qatari population. This study guides future efforts directed toward the prevention and management of MSK diseases. Further studies with a larger sample size are needed to verify the findings.

A Qualitative Study of Patients' Beliefs and Perception on Medicinal Properties of Natural Hot Spring Bath for Musculoskeletal Problems.

Natural therapy modalities such as thermal therapy and balneotherapy are commonly being practiced for the management of chronic aches and pain all over the world. Nepal has many such natural hot water springs among which few are famous for therapeutic purposes. Thousands of people with some musculoskeletal problem visit those places in the hope of getting rid of their problems. This study aimed to understand their belief in such therapies, expectations, and satisfaction after treatment along with their knowledge of the safety of hot spring water bath. Among 126 participants interviewed, 31% had inflammatory arthritis, followed by degenerative disorders in 29.4% and soft-tissue rheumatism in 12.7%. Around three-quarters believed that hot spring water has natural healing power and thus can improve their pain. Many even believed that water in natural springs is devoid of any chemicals. So, it is a safe treatment option. Regarding the expectation of cure, they had mixed opinions. Naïve participants hoped they might find a permanent cure in thermal baths. However, repeated visitors said that the effect usually lasted for a few months and they have to visit there regularly. Almost two-thirds of people thought that such natural treatment does not have any side effects. Few stated that they had faced certain problems after the treatment. The water tested from the study site showed that it contained a higher amount of chlorine and sulfate in comparison to other hot water springs in Nepal. The minerals present in water might be a cause of temporary relief of pain. Also, outbreaks of infection from common spring baths have to be considered as such cases have been reported in the past. In conclusion, the medicinal benefits of such natural hot water springs have to be studied further and awareness regarding safety should be given to the people seeking treatment.

AB1227 PREVALENCE OF RHEUMATIC MUSCULOSKELETAL DISORDERS IN A RURAL AREA OF UPPER EGYPT: WHO-ILAR COPCORD BASED COMMUNITY STUDY

Background:Rheumatic musculoskeletal disorders (RMSDs) are a common cause of long term pain and physical disability. In developed countries, RMSDS are a major cause of absence from work and thus have a big financial burden on the country economic status. Several studies have been published the incidence and prevalence of RMSDs in different world countries and found to be widely variable. Estimation of the extend of the problem of RMSDs in developing world, especially in rural economies will help better understanding of the risk factors that contribute to the initiation and progression of these diseases and help the health care authorities to provide proper health program services in these areas to reduce the physical and financial burden of RMSDs (Bagher et al., 2011; Majumdar et al., 2015 and Usenbo, et al., 2015).Objectives:To estimate the prevalence rate of RMSDs in a rural population in Upper Egypt.Methods:A cross-sectional based study was carried out and included 3988 subjects of population (2013 females and 1975 males). Mean age of patients was (46.89±15.25ys). They proceeded 4 phases of World Health Organization/International League of Associations for Rheumatology community-oriented program for control of rheumatic diseases survey questionnaire WHO-ILAR Community Oriented Program for screening of rheumatic diseases. Modified Health Assessment Questionnaire (HAQ) was used to assess the disability severity. Individuals suspected to have any rheumatic diseases were subjected to full clinical examination, laboratory and radiological investigations to reach a final diagnosis. They were classified according to appropriate criteria of diagnosis of diseases.Results:A prevalence rate of RMSDs was 16.22%, more prevalence in females (10.38% vs. 5.84% for males, P=0.000). The mean age of patients with RRMSDSs were older (46.89±15.25 yrs) than healthy individuals (29.56±18.95 yrs) (P=0.0001) and with increasing age (≥45-≤ 55 yrs).The identified RMSDs were OA (8.5%), Soft tissue rheumatism (STR) (6.57%), spinal disorders (SD) (6.47%), fibromyalgia (FM) (0.60%), RA (0.30%), arthralgia (0.18%), SPAs (0.15%), Gout(0.6%), Pseudogout (0.08%), SLE (0.5%), JIA(0.03) and MCTD (0.03%). The prevalence rates for the majority of RRMSDSs were higher in females and with increasing age. About two thirds of the patients had grade II disability.Conclusion:The prevalence rate of RMSDs in a rural population ≥15years in Upper Egypt has been estimated to be 16.22%.The most prevalent RMSDs are OA, STR and SD causing the greatest burden of the disease. The predictive risk of RMSDs has to be assessed in future studies.

Symptomatic joint hypermobility.

Joint hypermobility is relatively common and has many influences such as age, gender, training, and ethnicity among many. Joint hypermobility may be asymptomatic or symptomatic. It may also be non-syndromic or syndromic. However, "asymptomatic" joint hypermobility may result in repetitive use injury, alter biomechanics of joints at other body sites, or become symptomatic later in life. Symptomatic joint hypermobility can result from soft-tissue rheumatism (e.g. bursitis, tendonitis, etc.) or muscular tension pain due to muscular imbalance. Generalized joint hypermobility (GJH) can be easily assessed using a standardized, quick, in-office examination. Management is relatively straight forward once joint hypermobility is recognized using neuromuscular re-training. It is important to recognize that GJH may also be a feature of a heritable connective tissue disorder with other systemic findings. Therefore, assessing joint hypermobility in those with musculoskeletal complaints may lead to recognizing systemic manifestations and allow the appropriate management.

P93 Outcomes of enhanced triage of rheumatology referrals at a single point of access

Abstract Background With increasing pressure on rheumatology services there is a need to identify alternative pathways for patients which are better aligned to their needs. East Surrey CCG is formed of 17 GP practices serving an adult population of 137,000. First Community Health and Care acts as a single point of referral for patients with musculoskeletal conditions. In 2018 a triage service was established, run by a GP with an extended role (GPweR), for patients referred to rheumatology. Analysis of triaged patients was undertaken to explore the feasibility of diverting a subgroup of patients with non-inflammatory conditions into community-based care. Methods Referrals from February 2018 to March 2019 were analysed from the point of triage to confirmation of the diagnosis in secondary care. Triage was undertaken with additional reference to the primary care record in EMIS. For each referral it was recorded whether, according to the available information, this was more likely to be an inflammatory or non-inflammatory condition and whether they could have been seen first in a community GPwER rheumatology clinic. The final diagnosis after their hospital appointment was recorded. A pilot GPweR-led community clinic was established in April 2019 to see those patients selected by the process as suitable for community-based care. Results 407 patients were triaged. 96% were triaged to secondary care. Of these, records from the subsequent rheumatology appointment(s) were available for 312. The final diagnosis was inflammatory in 120 (38%) and non-inflammatory in 192 (62%). 152 patients (49%) were thought to have a non-inflammatory condition at triage which was confirmed in 83% of cases after a consultant appointment. 160 patients (51%) were thought likely to have an inflammatory condition which was confirmed in 59%. Positive predictive value of the triage process for non-inflammatory conditions was 83%, negative predictive value 59%, sensitivity 66%, specificity 79%. 57 patients selected from triage were seen in the pilot community clinic. Final diagnoses were: 53% fibromyalgia, 19% osteoarthritis, 12% soft tissue rheumatism, 14% gout/inflammatory arthritis. 54% of patients needed blood tests and 39% imaging. 31% required a face to face follow up appointment and 47% were referred to physiotherapy. 7% were referred on to rheumatology. Conclusion Referrals to secondary care rheumatology are rising and putting increasing pressure on services and referral to treatment times. There is a need to develop alternative pathways for patients with non-inflammatory conditions who could be managed in community settings. Our work shows that a majority of these can be identified at the point of triage with good specificity. We have also shown that of those seen in a pilot community clinic few needed onward referral. Our work suggests that there is a substantial opportunity to develop alternative and potentially more cost-effective community-based pathways for patients. Disclosures B. Forgie None. T. Garrood None.

EP26 Do early synovitis clinics triage patients with RA affectively?

Abstract Background In 2013, the UK National Institute for Health and Care Excellence (NICE) published quality standards for the treatment of rheumatoid arthritis (RA); emphasising the importance of early diagnosis and treatment of RA and these were updated in 2018. NICE quality statement 1 recommends that patients with a suspected inflammatory arthritis are referred to a rheumatology service within 3 working days of presentation. Quality statement 2 recommends that these patients are assessed in a rheumatology service within 3 weeks of referral. In view of these quality standards and the benefit of treating patients with RA, early Early Synovitis Clinics (ESC) were set up at the Royal Wolverhampton Trust (RWT). GPs were invited to refer patients electronically to the ESC if they had a swollen joint, positive antibodies (RhF or anti CCP) and if they suspected RA. All referrals to the ESC and all other new patient referrals were triaged by a consultant rheumatologist to determine if they were suitable for the ESC. Methods This is a retrospective service evaluation based on new patients seen in the ESC at the RWT over a 12month period, January to December 2018. The electronic records of patients seen in the ESC were retrospectively accessed and data was collected including gender, age and diagnosis. Results 284 new patients attended the ESC in 2018; 186 (65.49%) were female, 98 (34.51%) were male. The patients age ranged 18-95years with a mean age of 58.75. 72 patients (25.4%) were classified as having RA. 135 patients (47.54%) were classified as having inflammatory arthritis, diagnoses within the inflammatory arthritis group were: psoriatic arthritis, crystal arthritis, Palindromic rheumatism, polymyalgia rheumatica, Reactive arthritis and undifferentiated inflammatory arthritis. 84 patients (29.58%) patients received a diagnosis of osteoarthritis, 12 patients (4.22%) were classified as having a connective tissue disease, 44 (15.49%) of the 284 patients were diagnosed with a condition classified in the category of soft tissue rheumatism. Conclusion This analysis found while 47.54% of patients referred to the ESC at RWT received a diagnosis categorised as inflammatory arthritis, only 25.4% of patients had RA. This compares to the recent National Early Inflammatory arthritis audit where only 35% of patients seen in rheumatology clinics with suspected inflammatory arthritis had a subsequent confirmed diagnosis of an inflammatory arthritis. This suggests more guidance needs to be provided to primary care services regarding the indications for referral to the ESC in order to provide appropriate capacity for patients with RA to be reviewed and treated quickly. Disclosures N. Cleaton: None. T. Khan: None. S.R. Raizada: None.

Prevalence of comorbid conditions in rheumatoid arthritic patients diagnosed at a rheumatology clinic at a tertiary care hospital of western India

Background /Objectives: Rheumatoid arthritis (RA) is an auto immune disease affecting 1% of the world\'s population causing permanent deformation of the affected joint. The objective is to study the prevalence of different comorbidities found amongst the RA patients frequenting the rheumatology clinic at a tertiary care hospital of western India. Methodology: The study was carried amongst the RA patients frequenting the rheumatology outpatient clinic between the years January 2012 till December 2014. A Total of 6,158 patients of Rheumatoid arthritis were studied. All the patients were diagnosed based on the 2010 ACR standard classification criteria with their consent. Findings: Out of 6,158 patients surveyed, the disease was found to be more common in females (66.79%) than males (33.21%) making the ratio approximately 2:1. Comorbid conditions were associated with 34.33% of rheumatoid arthritis patients. The most frequent comorbid condition was found to be thyroid dysfunction with 16.68% patient population affected. Frequency of RA females (65.53%) was higher as compared to RA males (34.47%). Hypertension was the second most co prevalent disorder which was found in 12.34% of the patient population. Osteoporosis (3.33%), Soft tissue rheumatism (2.55 %) and Systemic Lupus Erythematous (0.86%) were also found in few of the RA patients. Application/Improvements: An in depth understanding of the frequency of prevalence of the different comorbid conditions to the rheumatoid arthritis patients will in future assure prompt and timely treatment for various diseases. Keywords: Rheumatoid Arthritis; Prevalence; Co-morbid conditions; Western India

Adhesive Capsulitis of Shoulder (Frozen Shoulder) among the Diabetic Patients with Rheumatic Complaints

Introduction: Adhesive capsulitis of shoulder is the most common soft tissue rheumatism among the diabetes patients with rheumatic complaints but the etiology is still unknown. To detect the incidence of adhesive capsulitis (frozen shoulder) among diabetic patients with rheumatic complaints.&#x0D; Materials and Methods: All patients having diabetes with rheumatic complaints attended in the department of Physical Medicine and Rehabilitation, BIRDEM and BSMMU, Dhaka during the period June 2003 to November 2003 were included in this study.&#x0D; Results: After discarding unsatisfactory samples, 273 samples were assayed for study. Out of 1665 patients 273 (16.40%) had adhesive capsulitis. Out of 273 patients 145 (53.12%) were female and 141 (51.65%) were housewives and of 206 (75.45%) patients was in age group 41-60 years.&#x0D; Conclusion: The incidence of adhesive capsulits of shoulder among diabetic patients female is more than male. It is found that housewives and elderly people are mostly sufferer with this disease.&#x0D; Medicine Today 2020 Vol.32(1): 67-69

Factors associated with health care seeking behavior for musculoskeletal pain in Indonesia: A cross-sectional study.

To assess the factors defining healthcare-seeking behavior of people with musculoskeletal pain in the urban community of Malang City, East Java, Indonesia. A cross-sectional survey was performed in Malang City, East Java, Indonesia. In total, 2067 participants aged 16-93years were interviewed. The sociodemographic and socioeconomic factors of healthcare seeking behavior, musculoskeletal pain, disability, and adverse drug reactions were assessed using the validated Indonesian version of Community Oriented Program for the Control of Rheumatic Disease (COPCORD) protocol by International League of Associations for Rheumatology and the World Health Organization core questionnaire. Chi-square test was applied to assess the determinants of health-seeking behavior for musculoskeletal pain. Slightly more than one-third of the respondents (36%) with musculoskeletal pain, described as osteoarthritis, low back pain, gouty arthritis, soft tissue rheumatism, and autoimmune arthritis, were assessed for their health-seeking behavior. About 73% of all those participants sought treatment for their musculoskeletal symptoms. Treatment modality used was modern healthcare, traditional healthcare, self-treatment using traditional medication, self-treatment using modern medication with the proportions of 20.94%, 25.23%, 33.95%, 25.77%, respectively. Disability significantly affected health-seeking behavior as the major determinant (prevalence ratio [PR] 1.087, 95% CI 1.031-1.146, P=0.002), followed by age (PR 1.043, 95% CI 1.000-1.087, P=0.049). Healthcare-seeking behavior was associated with the presence of adverse drug reactions (P<0.001). Factors associated with musculoskeletal pain health-seeking behavior were disability and age. Self and traditional healthcare treatment were further associated with an adverse drug reaction.

Drug-Induced Musculoskeletal Syndromes and Soft-Tissue Rheumatism

Drug-induced musculoskeletal syndromes represent a broad clinical spectrum, ranging from asymptomatic biological abnormalities to severe organ-threatening manifestations. Many drugs have been implicated in inducing rheumatological adverse events. For some compounds, there is pathological or epidemiological evidence for a causal link, and for others, the association is based on anecdotal reports. Several different types of musculoskeletal symptoms occur ranging from chondropathy to arthritis to periarticular symptoms. The most common afflictions are hyperuricemia and gout arising from a variety of commonly used medications such as antitubercular drugs, diuretics, and low-dose aspirin. Although virtually all drug classes may induce some form of musculoskeletal disorders, a significant chunk is corticosteroids, especially injectable, antibiotics, lipid-lowering agents, and newer generation antidiabetics. Knowledge of drug-induced musculoskeletal disorders avoids burdening the patient with an array of unnecessary investigations and allows optimal management of the patients, which includes early discontinuation of the offending agent.

Effects of Low Level Laser Therapy in Focal Soft Tissue Rheumatism: A Randomized Control Trial

Background: Treatment of focal soft tissue rheumatism is very important.Objective: The purpose of the present study was to see the effectiveness of low level laser therapy for the patients suffering from focal soft tissue rheumatism.Methodology: This randomized control trial was carried out in the Department of Physical Medicine and Rehabilitation at Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from March 2006 to August 2006 for a period of 6(six) months. The patients having focal soft tissue rheumatism were selected from the dept. of Physical medicine and Rehabilitation who were referred from other outpatient department of BSMMU and also from general practitioners outside the hospital. Patients were divided into two (02) groups designated as study group who were treated with Low level laser therapy, NSAIDs under the coverage of Omeprazole and ADL advice and control group who were treated with NSAIDs under the coverage of Omeprazole and ADL advices. Each group was treated and followed up for six weeks.Result: A total number of 44 patients were recruited for this study who were presented with different focal soft tissue rheumatism. Of these 44 patients, 32(73.0%) patients were female and 12 (27.0%) were male. Maximum patients belong to 31 to 50 years of age group in both sexes. The clinical improvement of group A was 84.0% and group B 60.0%. Results of the two groups were within narrow range.Conclusion: In conclusion though cannot be established, yet LLLT prove to be of some benefit to focal soft tissue rheumatism patients.Journal of National Institute of Neurosciences Bangladesh, 2018;4(1): 18-22

Incidence of Different Variant of Focal Soft Tissue Rheumatism Patients with Their Socio-demographic Profiles at a Tertiary Care Hospital in Dhaka City

Background: Focal soft tissue rheumatism occurs in varied incidence with difference socio-demographic group of patients.Objective: The purpose of the present study was to see the incidence of focal soft tissue rheumatism with the socio-demographic characteristics of the patients.Methodology: This descriptive type of cross-sectional study was carried out in the Department of Physical Medicine and Rehabilitation at Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from March 2006 to August 2006 for a period of 6(six) months. The patients having focal soft tissue rheumatism were selected from the dept. of Physical medicine and Rehabilitation who were referred from other outpatient department of BSMMU and also from general practitioners outside the hospital. The details of socioeconomic condition and the demographic characteristics were recorded.Result: During the study period a total of 2350 patients were examined. Among them 44 patients presented with different focal soft tissue rheumatism. The incidence of the patients presented with focal soft tissue rheumatism was 1.87%. Among 2350 patients, the incidence of different soft tissue rheumatism cases were Tennis elbow 20(85%), De-Quervain`s disease 12(51%), Trigger fingers 8(34%) and Golfers elbow 4(17%). The most common age group suffering from soft tissue rheumatism was the 31 to 40 years which was 20(46.0%) cases. Housewife was suffering most commonly with focal soft tissue rheumatism which was 14(32.0%) cases.Conclusion: In conclusion focal soft tissue rheumatism occurs most commonly among the young housewife presented with the tennis elbowJournal of Science Foundation 2018;16(1):8-12

Prevalence of Musculoskeletal Manifestations and Related Disabilities in a Peruvian Urban Population Living at High Altitude. COPCORD Study. Stage I

ObjectiveEstimate the prevalence of musculoskeletal manifestations and related disabilities of an urban population living at high altitude in Juliaca, Puno, Peru, using the Community Oriented Program for Control of Rheumatic Diseases (COPCORD) questionnaire and Health Assessment Questionnaire (HAQ) Disability Index. MethodsA cross-sectional study was performed in a sample of 1095 people. In each interview, the COPCORD methodology and the HAQ were applied. The city was divided into 8 sectors. ResultsIn all, 614 (56.1%) women were evaluated; 44% were from the Quechua community and 5.1% were Aymara. Before the final 7 days of the study, 132 people (12.05%; 95% CI 9.99–14.11) reported musculoskeletal pain. During the final 7 days of the study, 347 people (31.69%; 95% CI 28.36–35.02) who were predominately women (218; 35.5%; 95% CI 30.8–40.2) reported musculoskeletal pain. The most frequent rheumatic diseases were rheumatoid arthritis (1.27%), gout (0.64%), hand osteoarthritis (OA) (2.83%), knee OA (1.55%), hip OA (0.37%), fibromyalgia (1.09%), and soft tissue rheumatism (8.86%). The HAQ showed an incremental increase proportional to age. The HAQ average for the population was 0.18 (±0.36). Ten people (5.71%) of 175 with rheumatic disease received the services of a shaman. ConclusionIt is the first COPCORD study in an urban native population living at high altitude in Peru. The population affected by chronic rheumatic disease preferred professional rather than traditional care; this population had access to limited medical services. Impaired functional capacity measured by HAQ was associated with advanced age.

Associated Disease Profiles among the Patients Presented with Focal Soft Tissue Rheumatism

Background: There are several diseases related with the patients suffering from focal soft tissue rheumatism.Objective: The purpose of the present study was to observe the associated diseases among the patients suffering from focal soft tissue rheumatism.Methodology: This descriptive type of cross-sectional study was carried out in the Department of Physical Medicine and Rehabilitation at Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from March 2006 to August 2006 for a period of 6(six) months. The patients presented with focal soft tissue rheumatism were selected from the Department of Physical Medicine and Rehabilitation who were referred from other outpatient department of Bangabandhu Sheikh Mujib Medical University, Dhaka and also from general practitioners outside the hospital. The different associated diseases were recorded during the data collection.Result: A total of 44 patients were recruited who were presented with different focal soft tissue rheumatism. The incidence of different soft tissue rheumatism cases were Tennis elbow 20(85.0%), De-Quervain`s disease 12(51.0%), Trigger fingers 8(34.0%) and Golfers elbow 4(17.0%). Diabetes mellitus was found in 8(18.0%) cases. Hypertension was detected in 10(23.0%) cases. Patients presented with hypertension and diabetes mellitus were found in 6(14.0%) cases. Peptic ulcer disease was found in 12(27.0%) cases. However, others diseases were found in 8(18.0%) cases.Conclusion: In conclusion diabetes mellitus, hypertension and peptic ulcer disease are the most common diseases found among the focal soft tissue rheumatism patients.Journal of Current and Advance Medical Research 2018;5(1):19-22

Pattern of Musculo-Skeletal Disorders in Diabetic and Non-diabetic Patients Attending in a Tertiary Care Hospital in Dhaka

Background: Disorders of the musculoskeletal (MSK) system affect all ages and ethnic groups. This study was done to see the pattern of MSK disorders in diabetic and non-diabetic patients at a tertiary care hospital.Methods: This cross-sectional study was done between period of June 2016-Feb 2017 in the Department of Physical Medicine and Rehabilitation of a tertiary care hospital in Dhaka. Six hundred individuals were included in the study, 300 in diabetic and 300 in non-diabetic group.Results: Diabetic group consisted with 95 (31.67%) males, 205 (68.33%) females. Non-diabetic group consisted with 176 (58.67%) males and 124 (41.33%) females. Osteoarthritis knees (CoA of (101, 33.67%), degenerative lumber disc disease (69, 23%), frozen shoulder (60, 20%), degenerative cervical disc disease (42, 14%) and non-specific back pain (22, 7.3%), were common among diabetic patients. Among non- diabetic patients nonspecific back pain (55, 18.33%), degenerative lumbar disc disease (52, 17.33%), degenerative cervical disc disease (41, 13.66%), OA of knees (38, 12.60%), prolapsed lumbar inter- vertebral disc (PLID) (30, 10%) were common.Conclusion: Degenerative, non-inflammatory abnormalities comprised the major bulk of problems. Soft tissue rheumatism was common in diabetic patients. Frozen shoulder was present in higher percentage in diabetic patients.Birdem Med J 2018; 8(1): 68-71

Efficacy and Safety of Oral Diclofenac Sustained release Versus Transdermal Diclofenac Patch in Chronic Musculoskeletal Pain: A Randomized, Open Label Trial.

Introduction:To compare the efficacy, safety, and tolerability of transdermal patches of diclofenac sodium with oral diclofenac sustained release (SR) in patients of chronic musculoskeletal MSK pain conditions.Materials and Methods:The eligible patients were given either transdermal diclofenac patch or tablet diclofenac SR. Pain was assessed at 2 and 4 weeks using a visual analog scale. Adverse events were recorded. Patients with 18–65 years old of either gender with score of ≥4 on a 11-item numeric rating scale-numeric version of visual analog scale for pain with diagnosis of primary osteoarthritis (OA) of the knee or hand of at least 3 months duration, with independent radiological confirmation of OA or having pain associated with other MSK conditions such as soft-tissue rheumatism, cervical and lumbar back pain, and fibromyalgia, of at least 3 months duration were included in this study.Results:Transdermal diclofenac diethylamine patch and tablet diclofenac sodium sustained release (SR) do not significantly differ in the reduction of numerical rating scores at the end of 4 weeks (P = 0.8393).Conclusion:Transdermal diclofenac was equi-efficacious as tablet diclofenac sodium SR in reducing pain due to chronic MSK pain conditions.